Provider Demographics
NPI:1376892281
Name:IVORY-LINDSEY, IYANURA (RN)
Entity Type:Individual
Prefix:
First Name:IYANURA
Middle Name:
Last Name:IVORY-LINDSEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 N 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53206-1123
Mailing Address - Country:US
Mailing Address - Phone:414-732-1269
Mailing Address - Fax:414-875-7317
Practice Address - Street 1:3030 N 26TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53206-1123
Practice Address - Country:US
Practice Address - Phone:414-732-1269
Practice Address - Fax:414-875-7317
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI85547-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse